1. Field of the Invention
The present invention relates generally to the prevention of errors in medication administration, and in particular, to a method, apparatus, system, and article of manufacture for consistently displaying medication information.
2. Description of the Related Art
The proliferation of new drugs and increasing complexity of drug therapy has dramatically increased the incidence of medication errors and adverse drug events in hospitals. With the aging of the population, hospitals are treating more elderly and acutely ill patients whose ability to tolerate medication errors is compromised. At the same time, economic pressure from managed care and reduced reimbursement rates from public and private payors have caused hospitals to increase the patient/nurse ratio.
The process for administering drugs to patients has changed little in the past two decades. The process typically relies on verbal and written communication and involves several different clinicians from various areas within a hospital. Medication errors occur at every stage of the medication use processxe2x80x94in physician prescribing, order transcription, drug preparation, drug dispensing, and in administration to the patient. Existing information systems and automated drug distribution systems only incidentally address the problem of medication errors.
Several recent studies have documented the alarming rate of medication errors and adverse drug reactions in hospitals and their resulting deaths and related costs. Some of the findings are as follows:
6.5% of patients will experience a potentially serious error while hospitalized
over $4.0 billion in additional hospital costs are caused by medication errors and adverse drug events
Recently, the awareness of the high level of medication errors within hospitals has increased significantly and many leading hospitals in the United States have experienced highly publicized cases related to catastrophic medical errors. Lawsuits associated with medication errors have proliferated. In addition to the legal costs, hospitals"" institutional reputations may be at risk if there is a highly publicized patient death due to medication error.
In response to the growing risks of medication errors, leading hospitals have developed initiatives to focus on the issue. In addition, professional associations representing nurses, hospital pharmacists, and physicians have identified medication errors as a major issue. The Health Care Finance Administration (HCFA) has discussed regulations that would exclude hospitals with high rates of medication error from reimbursement under the Medicare program. As a result, many constituencies are seeking a standard of care within hospitals to address the problem of medication errors and adverse drug events.
A significant cause of medication error results from the inconsistent display and interpretation of medication information. Inconsistent displays and interpretations may arise at numerous stages in the processing and administration of medication including prescription interpretation, prescription order transcription and entry, medication dispensing (at a pharmacy), medication retrieval (by a nurse), medication administration, etc.
For example, a doctor may desire to write a prescription for 100 10 milligram tablets of medicine XYZ to be delivered orally 2 times a day. However, when writing the prescription, the doctor may write medicine XYZ using an abbreviation (e.g., X), with a dosage of 100.0 without indicating the dosage unit (e.g., mg (milligram) or xcexcg (microgram)) or dosage schedule/frequency (e.g., 2 times daily), and may fail to indicate the method of administration (e.g., oral). Such a prescription may not be consistently interpreted. For example, when entering the prescription into a computer system, the pharmacist may omit some of the missing important information, wrongly interpret the abbreviation, enter the information using abbreviations different from that used in the prescription (i.e., those used in the pharmacy""s own formulary), further abbreviate the remaining medication information (e.g., xc3x972 for two times daily), or incorrectly indicate a dosage of 1000 micrograms to be taken three times a day. Further errors may occur when the prescription is filled by another pharmacist that may interpret the information in the computer (e.g., the abbreviations) differently, when a nurse misinterprets the computer display of the prescription and obtains the wrong medication from floorstock, or when a nurse administers the medication and misinterprets the information.
Individual hospitals and pharmacies often use different abbreviations/formularies for medication information. Consequently, when personnel move from one hospital/pharmacy to another, there is a high likelihood that the personnel will misinterpret the medication information. Additionally, the medication information (and abbreviations) used on a prescription label may differ from the medication information displayed on the computer or on a medical administration record (MAR) that is used to record the status and treatment of a patient. Such differences may result in a medication error during the administration of the medication.
What is needed is the ability to consistently display and store medication information such that fewer errors are made when interpreting the information in a computer or on a MAR. Additionally, what is needed is a consistent and complete display of medication information across multiple sites.
A method and apparatus for consistently and accurately displaying medication information. Medication errors result in a significant number of injuries and deaths each year. One cause of medication errors includes the lack of consistence and reliability in the content and appearance of medication information. For example, different content for the same medication or the use of different abbreviations or terms when displaying the same medication may lead to the misinterpretation or improper use of a medication.
One or more embodiments of the invention provide a method, system, and article of manufacture for ensuring that the content and appearance of medication information is consistent, accurate, and reliable across multiple hospitals, sites, and users. Publicly available databases provide medication information. Relevant data is extracted from such databases and placed into a drug reference table.
Different hospitals and pharmacies maintain internal formularies that store and provide access to medication information provided by the hospital/pharmacy. Such information is often incomplete, inconsistent, and varies from hospital to hospital.
The drug reference table is combined with the formulary such that the medication information in the formulary is modified, completed, reformatted, etc. Such modifications, completions, and reformatting are conducted by enforcing one or more rules that are applied to elements and attributes of a medication. For example, rules may cause the conversion of a xe2x80x9cTxe2x80x9d in the formulary file to xe2x80x9cTABxe2x80x9d to indicate a medication""s route of administration. Similarly, leading or trailing zeroes may be removed, measurement unit abbreviations may be expanded or adjusted, capitalization may be adjusted, etc.
The resulting medication information content is stored in a hospital formulary file that is accessed and utilized for maintaining, displaying, administering, etc. medication.
To combine the drug reference table with the formulary, a hospital setup tool may be utilized. The hospital setup tool provides a graphical user interface with several columns. One column presents medication information from the formulary. A second column presents suggested medication information from the drug reference table. The suggested medication information is obtained by attempting to match the formulary information with relevant fields in the drug reference table. For example, if the national drug code (NDC) information stored in the formulary matches a NDC number from the drug reference table, the appropriate medication information is retrieved and displayed in the second column.
A third column presents the final medication information to be utilized in the hospital formulary file. Such final medication information may include a medication display description that will be used when the medication is displayed. The medication display description comprises multiple elements of a medication and may be adjusted by the user, if desired. For example, the medication display description may comprise a generic or brand display name of the medication (e.g., Morphine), followed by the strength and strength units (e.g., 200 mG).
Accordingly, a completed hospital formulary file reflects accurate and consistent medication information that the individual pharmacy or hospital has approved. Such medication information may then be utilized and displayed in a consistent manner to prevent medication errors. For example, all of the scheduled medications for a given patient may consistently display appropriate medication information for each patient order. Such information may include the medication display description and the dosage and route of administration information.